Lichen sclerosus

Lichen sclerosus

Paolo Inghirami1 – Orcid, Roberto Senatori– Orcid

1 – Medical Director, Obstetrics and Gynecology, S. Eugenio Hospital, Rome

2 – Freelance Professional, Villa Margherita Nursing Home, Rome

Corresponding author: Paolo Inghirami

inghiramip@tiscali.it


DOI: 10.53146/lriog120218

Abstract

Lichen Sclerosus (LS) is a chronic inflammatory disease of genital and extra-genital muco-cutaneous districts, presenting a double pick of incidence in pre-puberty and peri-post menopausal women. The pathognomonic symptomatology is represented by itch, but also pain, dysuria, restriction of micturition and entry dyspareunia. If not treated, it might cause a significant and permanent subversion of vulvar anatomy with scarring of the clitoral hood, stenosis, and disappearance of skin reliefs. Uncertainty exists around its pathogenesis, however, there are important hypotheses involving an autoimmune target for its formation and progression. The gold standard in treatment is topical steroids. Second line treatment includes calcineurin inhibitors, phototherapy, plated-rich plasma therapy, fractional Co2 laser. Surgery is reserved only for the treatment of obliterative complications such as introital stenosis. Patient education and long follow up have primary importance.

Keywords: lichen sclerosus; itching; topical steroids; differentiated VIN.


Available in LRIOG Nr.1 – 2021

e-ISSN: 1824-0283


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Bartholini’s gland cysts

Bartholini’s gland cysts

Franco Anglana – Orcid, Michela Angelucci – Orcid

 

Corresponding Author: Franco Anglana

franco.anglana@gmail.com


DOI: 10.53146/lriog120217

Abstract

Bartholin’s glands are symmetrical vestibular tubular glands that produce a clear, transparent fluid to lubricate the vulval vestibule. When the opening of these glands becomes obstructed, the fluid remains within the gland, causing a cyst. This condition is more frequent in nulliparous women and is rare in menopausal and postmenopausal women. The overall prevalence is 2%, and the average age of the patients is 20-29 years. If the fluid becomes infected with bacteria, the cyst develops an abscess. The most frequently isolated pathogens are Escherichia coli, Neisseria gonorrhoeae and Chlamydia trachomatis. The main symptom is a tender, painful lump near the vaginal opening associated with discomfort while walking or sitting and pain during intercourse. When taking a medical history, doctors should research triggers that might cause the duct to become obstructed (previous infections, poor hygiene, tight clothing, hair removal, oestrogen/progestin use and consequent vulvar atrophy). Bartholin’s cysts are easily diagnosed by clinical examination: no laboratory or radiographic tests are necessary. However, surgery is required to treat them. Marsupialization consists of suturing the cyst wall open to ensure the gland can drain freely, thus restoring its anatomical and functional integrity.

Keywords: cyst; abscess; bartolini gland; vulvar swelling; vulvar neoformation.


Available in LRIOG Nr.1 – 2021

e-ISSN: 1824-0283


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Clitoris: target of many vulvar diseases

Clitoris: target of many vulvar diseases

Pietro Lippa1 – Orcid, Federica Frascani2 – Orcid

1 – AIED, Viale Gorizia 14, Rome

2 – BIOS Via Archimede 12, Rome

Corresponding author: Pietro Lippa

dermatologopietrolippa@gmail.com


DOI: 10.53146/lriog120216

Abstract

This article aims to bring attention to how frequently the clitoris, despite being a small anatomical niche within the vulvar region, deserves careful diagnostic observation.
In fact, various inflammatory diseases often originate in the clitoral area and have specific clinical, symptomatic and perceptive characteristics. Lichen planus and scleroatrophic lichen are among the most frequent inflammatory vulvitis to originate in this anatomical region.
We describe in the morphological details all the diagnostic phases of these two pathologies. Often the pathologies affecting the clitoral area are subject to diagnostic delays for subjective reasons of the patients (delays in medical checks, long periods of tolerance of the disorders) or due to lack of attention from clinicians. We want to underline how an early intervention can determine a partial regression of an initial damage, its stabilization and, therefore, an improvement in the patient’s subjective perception with considerable advantages also for the relationship life. The clitoral area, being placed above the vulvar introitus, can very often be subject to in-depth observations. An adequate diagnostic observation, also with the help of the colposcope, a targeted biopsy and a consequent therapeutic behavior suitable for the clinical evolutionary phase in which the pathology itself is located, would also allow to intercept the possible proliferative changes that initially occur indeed in this anatomical site. On the basis of an algorithm based on these observations, it is possible to opt for drug therapy or non-invasive surgical therapy aimed at preventing and removing initially and potentially aggressive lesions.

Keywords: lichen sclerosus; lichen planus; vulva; clitoris; diagnosis; initial forms.


Available in LRIOG Nr.1 – 2021

e-ISSN: 1824-0283


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Vulvar pain and diagnosis of comorbidities

Vulvar pain and diagnosis of comorbidities
Key factors from the Vu-Net study on 1183 cases – part 1

Alessandra Grazziottin1 – Orcid, Dania Gambini 2 – Orcid, Filippo Murina3,4 – Orcid e i ricercatori del gruppo Vu-Net

1 – Director of the  Gynecology and Medical Sexology Center, H. San Raffaele Resnati, Milan

2 – Alessandra Graziottin Foundation for the treatment of pain in women – Onlus

3 – Lower Genital Tract Pathology Service, V. Buzzi Hospital – University of Milan
4 – Italian Vulvodynia Onlus Association

Corresponding author: Alessandra Graziottin

direzione@studiograziottin.it


DOI: 10.53146/lriog120215

Abstract

The Vu-Net (Vulvodynia Network) project is aimed at investigating chronic vul- var pain and its medical and sexual comorbidities, given its remarkable impact on the quality of life of both women and couples. The reported incidence of chronic vulvar pain (lasting 3-6 months) in women is 16%. This cross-sectional study involved 1183 patients with chronic vulvar pain attending 21 Italian medical centers from December 2016 to November 2018. 70.7% of enrolled women were between 20 and 49 years of age. Main diagnoses were spontaneous or provoked vestibulodynia (70.8%) and generalized vulvodynia (27.3%). The main reason for consultation was introital pain on penetration (64.2%), together with associated sexual dysfunctions, such as vaginal dryness (29.8%), hypoactive sexual desire disorder (22.1%) and sexual arousal disorder (21.3%). 48.3% had prolonged pain, lasting 1 to 5 years, with a mean diagnostic delay of 4 years and 7 months. The main comorbidities that emerged from the study include high association with intestinal disorders (94.7%), in particular IBS (27.3%), constipation (23.5%), and food allergies (10.1%); bladder infections (37.4%) including recurrent cystitis (19.5%) and post-coital cystitis (17.9%); recurrent vulvovaginal candidiasis (32%); headache (25.7%); mental disorders (22.6%); allergies (17.5%); endometriosis (11.7%). 77.4% of the Vu-Net patients had previously been treated without improving their condition. The analysis of the comorbidities allows the gynecologist to recognize the clusters of patients that will obtain the best results when treated with a multimodal intervention.

Keywords: chronic vulvar pain; dyspareunia; vulvovaginal candidiasis; comorbidities.


Available in LRIOG Nr.1 – 2021

e-ISSN: 1824-0283


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Extrammamary Paget’s disease of the vulva (EMPDV)

Extrammamary Paget’s disease of the vulva (EMPDV), this unknown

Francesco Sopracordevole1 – Orcid, Nicolò Clemente1 – Orcid, Anna del Fabro– Orcid

1 – CRO (Centro di Riferimento Oncologico – Oncological Reference Centre)  Cancer Institute Aviano

Corresponding author: Francesco Sopracordevole

fsopracordevole@cro.it


DOI: 10.53146/lriog120214

Abstract

Extramammary Paget’s disease of the vulva (EMPDv) is a rare neoplasia, with only intraepithelial spread in most of the cases, slowly evolving, with aspecific symptoms and high recurrence rate.
Extensive surgery is often necessary with repeated excision in case of recurrent disease. This can lead to significant genital disfigurement and impairment of the quality of life. Less invasive treatments (radiotherapy, immunotherapy, photodynamic therapy, laser ablation) have variable response and high recurrence rate. In case of invasive disease, poorly responsive to radio/chemotherapy, if a HER2 overexpression is detected, excisional surgery followed by specific target therapy is showing promising results. The key factor for the optimal management of EMPDv is the prompt diagnosis and treatment of lesions, in a multidisciplinary approach with proper therapies and a long-term follow-up, preserving the patient’s genital function and self-image.

Keywords: vulvar extramammary paget’s disease; surgery; diagnosis.


Available in LRIOG Nr.1 – 2021

e-ISSN: 1824-0283


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Vulvar condilomatosis

Vulvar condilomatosis

Roberto Senatori 1 – Orcid, Barbara Dionisi 2 – Orcid

1 – Board member of SICPCV (Italian Society of Colposcopy and Cervical Vaginal Pathology)

Board member of AGEO (Association of Extra-Hospital Gynecologists)

Coordinator of the Multi-specialty HPV Center, Villa Margherita Nursing Home, Rome

2 – Freelance Professional, Rome

Corresponding author: Roberto Senatori

robertosenatori@gmail.com


DOI: 10.53146/lriog120213

Abstract

Vulvar condylomatosis is a major health problem. It is a benign epithelial proliferative viral lesion that can affect any area of the vulvo-perineal district supported by human papilloma virus (HPV).
The clinical manifestation, the lesion recognizable through direct observation, is defined condyloma.
Often the patient realizes on her own the presence of condylomas in the vulval area or because she feels itchy during the growth phase of the formations, resulting in a strong emotional and psychosexual impact. Conventional diagnosis is based on clinical examination, also called vulvologic examination, which is the objective examination of the area as a whole. Only in very rare cases is a biopsy necessary. The most common diagnostic errors are related to genital, physiological or pathological manifestations, which can mimic the HPV-pathology and which require a different diagnostic and therapeutic approach. The aim of the therapy is to eliminate lesions, promote the remission of symptoms where present, prevent sequelae and restore the physiological morphology and function of tissues. The therapies, indicated by international guidelines, can be subdivided, according to the mode of action, into surgical, cytotoxic and immuno-modulating and are often used in combination with each other. The most important problem in the treatment of genital warts lesions is the high frequency of recurrence, estimated at 20-30%, which is a function of the host’s immunocompetence.
The only method to prevent HPV infection is vaccination.

Keywords: hpv; genital warts; therapy; recurrence; counselling.


Available in LRIOG Nr.1 – 2021

e-ISSN: 1824-0283


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